Experiences of Nurses Speaking Up in Healthcare Settings: A Qualitative Metasynthesis

Aim: To systematically review and synthesise qualitative research on nurses' experiences of speaking up in various contexts and to identify factors facilitating or impeding such a behaviour.

Design: This review was conducted as a qualitative metasynthesis, utilising the qualitative meta-ethnography approach.

Methods: A total of 6250 articles were screened. Two reviewers screened titles, abstracts and full texts. A total of 15 studies were included in this review. Researchers conducted a quality appraisal using the JBI critical appraisal checklist for qualitative research. An a priori protocol was created and registered on the Open Science Framework.

Data sources: Literature searches were conducted in five international bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL and ProQuest Dissertations and Theses Global) and five Korean databases (RISS, KISS, DBpia, KCI and NDSL).

Results: Three main themes were identified from the 15 studies used in the metasynthesis: (1) decisional complexity of speaking up, (2) motivators for speaking up and (3) barriers to speaking up. Nurses experienced challenges in speaking up. They were, and continue to be, concerned about negative responses. Hierarchy structure and poor work environment were identified as barriers to speaking up; professional responsibility and a supportive atmosphere were identified as facilitators for speaking up.

Conclusions: This review synthesised nurses' experiences of speaking up and influencing factors. Speaking up is crucial for nurses to improve patient safety, as frontline nurses are ideally positioned to observe early indicators of unsafe conditions in healthcare delivery.

Impact: Identified motivators and barriers of nurses' speaking-up behaviour offer considerations and opportunities for healthcare leaders and managers. This could lead to improvement in patient safety through the establishment of a safety culture that facilitates nurses' speaking-up behaviour.

Reporting method: The review adhered to the ENTREQ guideline.

Patient or public contribution: No patient or public contribution has been made in this review.